After Fetterman’s Stroke, Doctors Consider Senate Campaign Prospects

What is the real prognosis for John Fetterman, the Democratic Senate candidate from Pennsylvania, who suffered a stroke on May 13?

The 52-year-old governor of Pennsylvania won his party’s nomination just days later, setting up one of the most consequential Senate runs in the midterm elections. But pressing medical questions remain.

He has been discharged from hospital, his campaign said on Sunday, and Mr Fetterman has said doctors have assured him he will make a full recovery – but the campaign has not said when he will be available. can return to the campaign.

“I’m going to take the time now I need to rest and get to 100 percent so I can pick up the pace soon and flip this chair green,” Mr Fetterman said in a statement on Sunday, adding. that he feels “great” but plans to “continue to rest and recuperate.”

With such an important balance race, which could decide the majority in the Senate, Mr. Fetterman’s health is of great public concern. However, despite repeated requests, his campaign did not allow him or his doctors to be present to discuss his stroke and medical treatment.

And experts in stroke, heart disease and electrophysiology say that some of the campaign’s public statements do not offer a full explanation for Mr Fetterman’s described diagnosis or the treatment they claim. that he received.

The stroke was caused by a blood clot, he said in a statement released by his campaign. He said the blood clot was the result of atrial fibrillation, a condition in which the upper chambers of the heart beat erratically and out of sync with the lower chambers. The campaign said the clot was successfully removed by doctors at a nearby community hospital, Lancaster General Hospital.

On May 17, the day of the primaries, Fetterman was implanted with a pacemaker and defibrillator, which his press office said in a statement, “will help protect his heart.” him and addressed the underlying cause of his stroke, labyrinthine. flutter (A-fib), by adjusting his heart rate and rhythm. His press office said he expected to make a full recovery from the stroke.

Medical experts questioned Mr. Fetterman’s treatment with a defibrillator. They said it would only make sense if he had another condition that put him at risk of sudden death, like cardiomyopathy – a weakened heart muscle. Such a heart condition may have caused the blood clot. Or, the doctors say the campaign may be right about afib causing blood clots.

Thrombotomy, the method likely used to remove the clot, also indicated that Mr Fetterman had experienced more than one mini-stroke, although prompt treatment could have prevented further damage. injured and saved his brain.

Mr Fetterman said in a statement: “I have been in the hospital for just over a week. “I am aware that this is serious and I am taking my recovery seriously.”

In a short interview on May 20, Gisele Barreto Fetterman, Mr. Fetterman’s wife, told the story of his stroke, from her point of view.

“We were on the campaign trail,” she said. “We had breakfast and he felt fine.”

The couple got into a car to go to an event at Millersville University, where, she said, “the left corner of his mouth fell down in just a second.”

“I had a hunch that something was going on,” Ms. Fetterman said. “I shouted to the soldier, ‘I think he had a stroke.’ He said, ‘I’m fine. What do you talking about? I feel fine. ‘”

State troopers soon transported Mr. Fetterman to Lancaster General Hospital, where he began treatment. Ms Fetterman said it involved going through his groin, which suggested he had a thrombectomy, a procedure in which doctors slide a small plastic tube through the groin, inserting it into the brain. and then pull out the clot by suction or wire mesh. .

It wasn’t until two days later that his campaign reported that Mr. Fetterman had been hospitalized with a stroke. Asked about the delay, Ms. Fetterman said, “Less than 48 hours is quite an impressive time when dealing with sensitive medical issues.”

Immediately after that question, Rebecca Katz, a senior adviser to Mr. Fetterman’s campaign, abruptly ended the call with Ms. Fetterman.

Medical experts say some aspects of the story are hard to reconcile with their knowledge of stroke treatment.

Dr. Lee Schwamm, a stroke specialist at Massachusetts General Hospital and a professor of neurology at Harvard Medical School, says doctors only perform thrombectomy when a large artery in the brain is blocked. congestion.

“You wouldn’t normally do that to someone who’s just a little saggy in the face,” he says. Dr Schwamm wondered if the doctors who examined Mr Fetterman in the hospital noticed other symptoms, such as loss of left-side vision or a lack of awareness of his left side, commonly referred to as “apathy”.

“These strokes tend to be very serious,” says Dr. Schwamm. “He was lucky to have gone to a hospital that could be treated.”

Frustrated by the stroke symptoms as described by Ms. Fetterman, a spokesman for Mr. Fetterman wrote in an email that he “told the Associated Press last week that Gisele ‘realized that John was not himself, and soon he began to stutter. ‘”

But what caused the stroke?

Ms Fetterman said her husband knew he had atrial fibrillation, a high risk of stroke, and that he was taking anticoagulants, a standard method of reducing stroke risk in people with atrial fibrillation, “on and off” Turn off”.

But the pacemaker and defibrillator treatment is a puzzle if all he has is atrial fibrillation, medical experts say.

“This doesn’t quite make sense,” said Dr. Brahmajee Nallamothu, an interventional cardiologist at the University of Michigan.

Elaine Wan, associate professor of medicine in cardiology and cardiac electrophysiology at Columbia University Medical Center, says defibrillators – which are always accompanied by pacemakers – are used to prevent strokes. death. They are often implanted in people with weakened heart muscles, or survivors of a cardiac arrest, or in people with a genetic predisposition to sudden cardiac death.

“We wouldn’t use it for atrial fibrillation,” says Dr. Wan.

Rajat Deo, an associate professor of medicine and cardiac electrophysiologist at the University of Pennsylvania’s Perelman School of Medicine, agreed about the use of a defibrillator and said he shared Dr. Wan that Mr. Fetterman suffered heart damage.

“I think it would be fair to say that he had at least two separate problems,” Dr. Deo said of Mr. Fetterman. “One is afib, from which he most likely had a stroke that was successfully treated.”

He added, “The second issue is that he may have some underlying heart condition that increases the risk of ventricular arrhythmias and therefore sudden cardiac death.”

Dr. Deo says that afib fiber may be related to another condition. Patients with weakened heart muscles are also at risk for atrial fibrillation.

On the other hand, Dr Deo said, Mr Fetterman’s atrial fibrillation may have nothing to do with his failing heart. Without more information from his doctors it is impossible to know.

Dr Deo added that if Mr Fetterman is receiving appropriate modern medical therapies and is protected with a defibrillator from sudden cardiac death, “he will do quite well while continuing his campaign. me”.

Experts also raise concerns about the prospects for former Vice President Dick Cheney, who was implanted with a defibrillator in 2001. He has completed two terms in the White House, including a full re-election run. tough times in 2004.

And there’s still time before the Pennsylvania general election campaign begins in earnest: It’s unclear who Mr. Fetterman’s opponent will be, as the Republican race is still too close to call and could move towards control. vote again.

But Dr. Wan is less optimistic than Dr. Deo about Mr. Fetterman.

“He was at risk of sudden cardiac death,” she said. “For someone in the campaign that could be cause for concern.”

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